| NPI | 1255959706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2189DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004240A) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-10-05 |